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November 8, 2020

A Day in the Life of an Anesthesia Provider During a Global Pandemic

November 8, 2020

The coronavirus pandemic has taken a toll on just about everyone. However, healthcare professionals have experienced some of the most acute effects on their physical and emotional health, and even on their financial wellbeing. 

We reached out to anesthesia providers to better understand what the day-to-day looked like for them during these times and learn more about their efforts on behalf of the safety and care of all involved. Back in August, we told Lisa’s story and how the pandemic caused patient/provider interactions to drastically change. Read her story here. 

This next story is from the perspective of Jeff, a Chief CRNA in Northeast Alabama. 

 

Facing Financial Adversity

From my perspective, COVID-19 officially arrived at our hospital on March 22, the day we ceased elective cases. It was then we were given a new compensation package and were asked to sign new employment contracts. In other words, we were introduced to a world of pay cuts by 50% overnight.

Our CRNA group has always been very close. When faced with employee cutbacks in the past, we creatively dealt with them by cutting everyone’s pay and increasing our off time, so that everyone was able to keep their jobs. We’re familiar with the cyclical nature of our hospital’s business and how we’re often the beneficiaries of poor decisions made elsewhere. Our response is to face the challenges head-on, knowing that the hospital and patients rely on us, no matter the situation. 

These decisions to sacrifice for the greater good have encouraged us to know that we can weather any storm, including one presented by a pandemic. On March 22, 2020, the hospital told us it only needed three CRNAs per day, a significant drop from the seven to eight we had at the hospital in a typical week. Our group informed us that they would pay three CRNAs a per diem rate, and pay 1st and 2nd call. Our team decided to spread the work out as evenly as possible and split the total income -- that way, we would all have a stable and predictable paycheck. However, so work could be distributed as evenly as possible, we needed to scrap the existing schedule and start from scratch. 

As you can imagine, taking a 50% cut in pay can be a big shock. These are the times when you’re grateful to have an emergency fund and to be living within a strategic budget. Personal finance advisor Dave Ramsey had fortunately prepared me for this day. We may have had a reduction in hours, but as Chief CRNA, I had many conversations reassuring our crew that these types of measures were taking place across the nation. I spoke to other chiefs and compared notes with CRNAs from around the region. I shared all of the information gathered to let everyone know that this wasn’t just our new normal, but that others were going through very similar situations. In challenging conditions like these, transparency is key. 

Rapid Changes in Protocol and the Environment 

Financial adversity was just one of the challenges. We began researching existing data on the emerging virus, but scientific evidence was scant and practice recommendations were changing overnight. We had to reacquaint ourselves with PPE protocols, and the proper and safest way to “don it” (put it on) and “doff it” (take it off). 

These were new and scary times. I remember talking with friends, and they were saying they couldn’t wait until all this was over, so their maid could come to clean their house or they could get a pedicure. I said I couldn’t wait to be able to go to work without fearing for my life. 

In April, we found out that one of our own tested positive for coronavirus. One of our CRNAs had developed the virus after intubating a COVID-positive patient in the ICU. The intubation had been difficult, and he even mentioned to us afterward that if he didn’t get it from that patient, he’d be surprised. As it turned out, he had his first symptoms less than a week later. 

Having one of our own sick with this virus reaffirmed just how careful we all needed to be. Fortunately, our friend was in very good health, and his course was relatively mild. He experienced a loss of stamina, body aches, intermittent fevers, and some shortness of breath. During his quarantine, his wife -- who is an RN -- took great care of him and avoided contracting the virus herself. Within approximately three weeks, he was able to return to work.

We were able to resume elective cases by the beginning of May. Still, we had to reverse this decision within a month, due to the overwhelming number of COVID patients, and the shortage of staff and supplies straining our system. This shutdown only lasted about three weeks before we were able to return to taking elective cases.

 

My Experience With the Virus

As a department head, I tried my best to be a great example of wearing personal protective gear. I would don my N95 mask before introducing myself to any patients. I would put on a non-permeable gown, gloves, and eye protection before inducing general anesthesia upon all patients. When intubating known COVID patients, I would follow all CDC guidelines. 

However, on July 27th, after spreading pine straw in my yard on a hot day, I began to experience what I believed to be hay fever symptoms, such as nasal congestion. On the 28th, symptoms progressed to a mild cough. By the 30th, I woke with a low-grade fever and knew I was in trouble. I went in early to work and told the OR Charge nurse that I was going to get tested in the ER. I had my test at 0730, and by noon I found out that I was COVID-19 positive. All I could figure is I had contracted it from a patient on whom we had operated a week prior for a MAC anesthetic – it was discovered that she was positive a few days later.  

After seeing so many people with serious illnesses related to the virus, getting a positive test result was a scary moment. I knew I was in good physical shape, but there was always a possibility of an outlier response. My daughter was due to move into her dorm within a week for her freshman year at Auburn, and fortunately, I had not been in close contact with her in the previous few days. For my family’s safety, I decided to quarantine in our camper at a nearby campsite. I consulted a few physicians I trusted and decided to treat myself with Azithromycin, Hydroxychloroquine, zinc, vitamin C, and melatonin. In my isolation, I began to consume every bit of data on the virus and treatment protocols, and I felt confident with the treatment regimen that I was on. 

I had a fever for about 30 hours, had gastrointestinal symptoms, and was more tired than usual. I felt it was important to stay active, so I made an effort to walk at least a mile a day. I had no respiratory involvement, so I steadily increased my distance until I was walking 5-6 miles a day. Within a week, I was feeling back to normal. 

Then, my wife started having symptoms. She had already moved my daughter into her dorm (without me) and showed initial symptoms similar to what I experienced. Her medicinal regime was the same as mine, minus the hydroxychloroquine. Her illness seemed slightly more severe than mine, and I can’t help but wonder if this was due to the absence of hydroxychloroquine in her treatment. However, the medicine prescribed to those with the virus can depend on the physician and their experiences with or belief in the effectiveness of certain drugs.  

At the end of the day, my wife and I felt blessed that our course was very mild, as the virus can be extremely unpredictable. 

 

This year has been exceptionally stressful. Our anesthesia group has not been able to gather together for social events, we have all had COVID hit close to home with many of our loved ones, and we have endured the day-to-day stress that goes along with the ever-present threat to the safety of ourselves and our loved ones. Still, I am very grateful to work with an extraordinary team of CRNAs and nurses. We will get through this together.

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